Intermediaries Vital to the Public Health Data Ecosystem – Association of State and Territorial Health Officials | ASTHO

Report on Public Health Data Exchange and its Contribution to Sustainable Development Goals

The timely, accurate, and complete exchange of health data is fundamental to achieving Sustainable Development Goal 3 (SDG 3): Good Health and Well-being. Robust data systems empower public health agencies to mitigate community health threats, prevent the spread of infectious diseases, and reduce chronic conditions, directly supporting SDG Target 3.d concerning early warning and risk management. Public health intermediaries—entities facilitating health data exchange—are critical in building the resilient infrastructure (SDG 9) and fostering the multi-stakeholder partnerships (SDG 17) necessary to overcome existing data access challenges.

Current public health intermediaries demonstrate a foundational capacity for enhancing health systems. Key examples include:

• The Immunization (IZ) Gateway
• State and Territorial Exchange of Vital Events (STEVE)
• The BioSense Platform
• The Association of Public Health Laboratories Informatics Messaging Services (AIMS)

As health information technology evolves, it is imperative to explore additional intermediary solutions that complement existing platforms to advance progress toward global health targets.

Enhancing Regional and State Health Systems Through Intermediaries

At regional, state, and local levels, Health Information Exchanges (HIEs) and Health Data Utilities (HDUs) serve as vital intermediaries. They facilitate data exchange between healthcare organizations and public health agencies, strengthening local health infrastructure in line with SDG 9 and enabling the targeted interventions required to meet SDG 3.

HIE Successes and Legislative Support for SDG Infrastructure

The effectiveness of HIEs in advancing public health goals is demonstrated by Virginia’s Fairfax County Health Department, which utilized its state HIE to reduce the time for accessing critical HIV case data from two weeks to five minutes. This efficiency directly contributes to better disease management and public health response, aligning with SDG 3.

Recent legislative actions underscore a growing commitment to strengthening this critical infrastructure, a key component of SDG 9:

• Vermont (S 126): Mandates collaboration with the state HIE to develop a Unified Health Data Space, aiming to improve health data access and reduce costs.
• Wisconsin (SB 108): Authorizes the use of the state HIE to create a portal for sharing safety plans for minors in crisis, supporting mental health and well-being.
• Maine (LD 84): Expands medical record access for the Office of Child and Family Services via the state HIE, ensuring continuity of care for vulnerable children.

These legislative efforts formalize the role of HIEs in creating a more integrated and responsive health system.

Health Data Utility (HDU) Capabilities for Holistic Health Insights

HDUs build upon HIE infrastructure to offer advanced analytic capabilities. By combining clinical, non-clinical, and public health data, HDUs provide holistic, longitudinal insights into community health. This enriched data is actionable, enabling more effective strategies to address health inequities and improve overall community well-being, which is central to achieving SDG 3.

Connecting Intermediaries to Public Health: A Partnership for the Goals (SDG 17)

The integration of HIEs and HDUs with public health agencies exemplifies SDG 17: Partnerships for the Goals. A 2023 survey found that 86% of the 90 identified HIEs in the United States were electronically connected to at least one health agency. These partnerships are primarily focused on immunization, laboratory, and syndromic surveillance reporting. With adequate funding, there is significant potential to expand these collaborations to include other critical public health use cases, such as electronic case reporting and vital statistics, thereby strengthening the capacity for health monitoring and response.

A National Framework for Health Data Exchange: TEFCA

The Trusted Exchange Framework and Common Agreement (TEFCA) represents a national-level initiative to build a voluntary, nationwide system for health data exchange. This framework supports the development of resilient national infrastructure (SDG 9) by creating a network of Qualified Health Information Networks (QHINs) to streamline data sharing and reduce technological and financial burdens on the health system.

TEFCA Implementation and Challenges

Early demonstrations of TEFCA have yielded mixed results, highlighting both its potential and the challenges in its implementation. In one successful case, the Washington State Department of Health and the Oregon Health Authority exchanged electronic case reporting data with a multi-state health system through a single QHIN connection. This success demonstrates TEFCA’s ability to improve efficiency and foster cross-state collaboration, contributing to SDG 3.

Conversely, the Fairfax County Health Department experienced minimal response when querying the network for case investigation data. This was largely due to public health not being a required exchange purpose under TEFCA, leading to provider concerns about data privacy. This challenge underscores the need for clear policies and trust-building to fully leverage such networks for public health good.

Improving Data Exchange through Enhanced Collaboration (SDG 17)

Addressing the challenges of TEFCA requires strengthening multi-stakeholder partnerships, a core principle of SDG 17. Both the Washington and Fairfax County projects developed communication strategies to articulate the value proposition for healthcare providers to exchange data with public health. These benefits include reducing administrative burden and costs. Broadening these communication efforts and developing more detailed standard operating procedures are necessary to increase provider participation and ensure the network effectively supports public health objectives and the broader goals of SDG 3.

Conclusion: An Integrated Approach to Achieving Health Goals

Public health intermediaries play distinct yet complementary roles in advancing public health. HIEs and HDUs provide essential data quality, governance, and analytics at the regional level, while TEFCA offers a national network to connect these entities. Leveraging these intermediaries in a coordinated manner is crucial for building the resilient data infrastructure (SDG 9) and fostering the collaborative partnerships (SDG 17) required to achieve the ambitious targets of SDG 3: Good Health and Well-being for all.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on public health data exchange connects to several Sustainable Development Goals (SDGs) by focusing on improving health outcomes, building resilient infrastructure, fostering partnerships, and strengthening institutions.

• SDG 3: Good Health and Well-being: This is the most central SDG. The article’s primary focus is on leveraging data to “mitigate threats to a community’s health, such as identifying and preventing the spread of infectious diseases and reducing the prevalence of chronic conditions.”
• SDG 9: Industry, Innovation, and Infrastructure: The article extensively discusses the technological infrastructure and innovative platforms—such as Health Information Exchanges (HIEs), Health Data Utilities (HDUs), and the Trusted Exchange Framework and Common Agreement (TEFCA)—that are essential for modern public health data exchange.
• SDG 16: Peace, Justice, and Strong Institutions: The article highlights the role of legislation and governance in establishing effective and accountable systems for health data. It provides examples of states like Vermont, Wisconsin, and Maine enacting laws to formalize and strengthen their health information exchange frameworks, thereby building stronger public health institutions.
• SDG 17: Partnerships for the Goals: The entire data exchange ecosystem described relies on multi-stakeholder partnerships. The article emphasizes collaboration between public health agencies, healthcare providers, laboratories, and technology intermediaries (HIEs/HDUs) at local, state, and national levels.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s discussion of health data systems and their applications, several specific SDG targets can be identified:

1. SDG 3: Good Health and Well-being

   • Target 3.3: End the epidemics of AIDS… and other communicable diseases. The article directly supports this target with the example of Virginia’s Fairfax County Health Department using an HIE to access HIV case data, which “reduced the time it typically takes to receive HIV data from clinicians from two weeks to five minutes.” This rapid access is crucial for case investigation and preventing further spread.
   • Target 3.4: Reduce by one third premature mortality from non-communicable diseases… and promote mental health and well-being. The article mentions that a key goal of improved data access is “reducing the prevalence of chronic conditions.” Furthermore, it cites Wisconsin’s legislation (SB 108) to use its HIE “to create a portal for sharing safety plans that assist minors during behavioral or developmental crises,” which directly relates to promoting mental and developmental health.
   • Target 3.d: Strengthen the capacity… for early warning, risk reduction and management of national and global health risks. The entire premise of the article—using intermediaries like the BioSense Platform for syndromic surveillance and AIMS for laboratory data exchange—is about strengthening the capacity for early warning and risk management of health threats. The TEFCA framework is presented as a national-level solution to improve this capacity.

2. SDG 9: Industry, Innovation, and Infrastructure

   • Target 9.1: Develop quality, reliable, sustainable and resilient infrastructure… to support… human well-being. The article describes the development and expansion of HIEs, HDUs, and the national TEFCA network as critical digital infrastructure. The fact that a 2023 survey identified 90 HIEs, with 86% connected to a health agency, demonstrates the development of this infrastructure to support public health and well-being.

3. SDG 16: Peace, Justice, and Strong Institutions

   • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The article provides concrete examples of states creating stronger institutional frameworks through legislation. Vermont’s S 126, Wisconsin’s SB 108, and Maine’s LD 84 are all legislative actions that formalize the role of HIEs, making the system of data exchange more effective and accountable.

4. SDG 17: Partnerships for the Goals

   • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The article is a showcase of such partnerships. It describes collaborations between state health agencies and HIEs (e.g., Fairfax County and Virginia Health Information), federal funding for state-level projects, and the TEFCA model, which relies on a network of public and private participants (QHINs, providers, health agencies) working together.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several quantitative and qualitative indicators that can be used to measure progress:

• Time required to access critical health data: A direct indicator mentioned is the reduction in time to receive HIV data in Fairfax County, which dropped “from two weeks to five minutes.” This measures the efficiency of the health surveillance system (relevant to Target 3.3 and 3.d).
• Number of point-to-point connections: The article states that both HIEs and TEFCA help reduce the number of individual connections needed for data exchange. This can be counted and used as an indicator of system efficiency and reduced technological costs (relevant to Target 3.d and 9.1).
• Percentage of HIEs connected to public health agencies: The article cites a “2023 survey” that found “86% of which were in 45 states electronically connected to at least one health agency.” This percentage is a clear indicator of the reach and integration of health data infrastructure (relevant to Target 9.1).
• Number of jurisdictions enacting supportive legislation: The article lists specific bills in Vermont, Wisconsin, Maine, New Mexico, Michigan, and Puerto Rico. Counting the number of states or territories with formal legal frameworks for HIEs/HDUs serves as an indicator of institutional strengthening (relevant to Target 16.6).
• Scope of data exchange use cases: The article notes that HIEs primarily enable reporting for “immunization, laboratory, and syndromic surveillance data” and that there are opportunities to expand to “electronic case reporting and vital statistics data.” The number and type of use cases supported can measure the maturity of partnerships and infrastructure (relevant to Target 17.17 and 3.d).
• Participation rate in national exchange frameworks: For TEFCA, the article notes that responses to queries were “minimal” initially due to low provider participation. An increase in the number of providers and health agencies actively exchanging data via QHINs would be a key indicator of the framework’s success (relevant to Target 17.17).

4. Summary Table of SDGs, Targets, and Indicators

Source: astho.org